Zachary F Meisel1, Joshua P Metlay2, Lauren Sinnenberg3, Austin S Kilaru4, Anne Grossestreuer3, Frances K Barg5, Frances S Shofer3, Karin V Rhodes6, Jeanmarie Perrone7. 1. Center for Emergency Care Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: zfm@wharton.upenn.edu. 2. Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA. 3. Center for Emergency Care Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 4. Department of Emergency Medicine, Highland Hospital, Oakland, CA. 5. Department of Family Medicine and Department of Anthropology, University of Pennsylvania, Philadelphia, PA. 6. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Emergency Medicine, Northshore Long Island Jewish Hospital, New Hyde Park, NY. 7. Center for Emergency Care Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Division of Medical Toxicology, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Abstract
STUDY OBJECTIVE: Clinical guidelines are known to be underused by practitioners. In response to the challenges of treating pain amid a prescription opioid epidemic, the American College of Emergency Physicians (ACEP) published an evidence-based clinical policy for opioid prescribing in 2012. Evidence-based narratives, an effective method of communicating health information in a variety of settings, offer a novel strategy for disseminating guidelines to physicians and engaging providers with clinical evidence. We compare whether narrative vignettes embedded in the ACEP daily e-newsletter improved dissemination of the clinical policy to ACEP members, and engagement of members with the clinical policy, compared with traditional summary text. METHODS: A prospective randomized controlled study, titled Stories to Promote Information Using Narrative trial, was performed. Derived from qualitative interviews with 61 ACEP physicians, 4 narrative vignettes were selected and refined, using a consensus panel of clinical and implementation experts. All ACEP members were then block randomized by state of residence to receive alternative versions of a daily e-mailed newsletter for a total of 24 days during a 9-week period. Narrative newsletters contained a selection of vignettes that referenced opioid prescription dilemmas. Control newsletters contained a selection of descriptive text about the clinical policy, using length and appearance similar to that of the narrative vignettes. Embedded in the newsletters were Web links to the complete vignette or traditional summary text, as well as additional links to the full ACEP clinical policy and a Web site providing assistance with prescription drug monitoring program enrollment. The newsletters were otherwise identical. Outcomes measured were the percentage of subjects who visited any of the Web pages that contained additional guideline-related information and the odds of any unique physician visiting these Web pages during the study. RESULTS: There were 27,592 physicians randomized, and 21,226 received the newsletter during the study period. When each physician was counted once during the study period, there were 509 unique visitors in the narrative group and 173 unique visitors in the control group (4.8% versus 1.6%; difference 3.2%; 95% confidence interval [CI] 2.7% to 3.7%). There were 744 gross visits from the e-newsletter to any of the 3 Web pages in the narrative group compared with 248 in the control group (7.0% versus 2.3%; odds ratio 3.2; 95% CI 2.7 to 3.6). During the study, the odds ratio of any physician in the narrative group visiting one of the 3 informational Web sites compared with the control group was 3.1 (95% CI 2.6 to 3.6). CONCLUSION: Among a national sample of emergency physicians, narrative vignettes outperformed traditional guideline text in promoting engagement with an evidence-based clinical guideline related to opioid prescriptions. Copyright Â
RCT Entities:
STUDY OBJECTIVE: Clinical guidelines are known to be underused by practitioners. In response to the challenges of treating pain amid a prescription opioid epidemic, the American College of Emergency Physicians (ACEP) published an evidence-based clinical policy for opioid prescribing in 2012. Evidence-based narratives, an effective method of communicating health information in a variety of settings, offer a novel strategy for disseminating guidelines to physicians and engaging providers with clinical evidence. We compare whether narrative vignettes embedded in the ACEP daily e-newsletter improved dissemination of the clinical policy to ACEP members, and engagement of members with the clinical policy, compared with traditional summary text. METHODS: A prospective randomized controlled study, titled Stories to Promote Information Using Narrative trial, was performed. Derived from qualitative interviews with 61 ACEP physicians, 4 narrative vignettes were selected and refined, using a consensus panel of clinical and implementation experts. All ACEP members were then block randomized by state of residence to receive alternative versions of a daily e-mailed newsletter for a total of 24 days during a 9-week period. Narrative newsletters contained a selection of vignettes that referenced opioid prescription dilemmas. Control newsletters contained a selection of descriptive text about the clinical policy, using length and appearance similar to that of the narrative vignettes. Embedded in the newsletters were Web links to the complete vignette or traditional summary text, as well as additional links to the full ACEP clinical policy and a Web site providing assistance with prescription drug monitoring program enrollment. The newsletters were otherwise identical. Outcomes measured were the percentage of subjects who visited any of the Web pages that contained additional guideline-related information and the odds of any unique physician visiting these Web pages during the study. RESULTS: There were 27,592 physicians randomized, and 21,226 received the newsletter during the study period. When each physician was counted once during the study period, there were 509 unique visitors in the narrative group and 173 unique visitors in the control group (4.8% versus 1.6%; difference 3.2%; 95% confidence interval [CI] 2.7% to 3.7%). There were 744 gross visits from the e-newsletter to any of the 3 Web pages in the narrative group compared with 248 in the control group (7.0% versus 2.3%; odds ratio 3.2; 95% CI 2.7 to 3.6). During the study, the odds ratio of any physician in the narrative group visiting one of the 3 informational Web sites compared with the control group was 3.1 (95% CI 2.6 to 3.6). CONCLUSION: Among a national sample of emergency physicians, narrative vignettes outperformed traditional guideline text in promoting engagement with an evidence-based clinical guideline related to opioid prescriptions. Copyright Â
Authors: Austin S Kilaru; Jeanmarie Perrone; Catherine L Auriemma; Frances S Shofer; Frances K Barg; Zachary F Meisel Journal: Acad Emerg Med Date: 2014-03 Impact factor: 3.451
Authors: Robert J Smith; Karin Rhodes; Breah Paciotti; Sheila Kelly; Jeanmarie Perrone; Zachary F Meisel Journal: Ann Emerg Med Date: 2015-04-09 Impact factor: 5.721
Authors: David A Nace; Laurie R Archbald-Pannone; Muhammad S Ashraf; Paul J Drinka; Elizabeth Frentzel; Swati Gaur; Dheeraj Mahajan; David R Mehr; William C Mercer; Philip D Sloane; Robin L P Jump Journal: J Am Med Dir Assoc Date: 2017-02-01 Impact factor: 4.669
Authors: David A Nace; Joseph T Hanlon; Christopher J Crnich; Paul J Drinka; Steven J Schweon; Gulsum Anderson; Subashan Perera Journal: JAMA Intern Med Date: 2020-07-01 Impact factor: 21.873
Authors: Alene Kennedy-Hendricks; Emma E McGinty; Amber Summers; Susan Krenn; Michael I Fingerhood; Colleen L Barry Journal: JAMA Netw Open Date: 2022-02-01
Authors: Tamara M Haegerich; Christopher M Jones; Pierre-Olivier Cote; Amber Robinson; Lindsey Ross Journal: Drug Alcohol Depend Date: 2019-09-19 Impact factor: 4.852